frequently asked questions
The end-of-life process often brings fear and deep emotions for the patient, as well as the family. The hopes and triumphs of one day blend with the concerns and fears of another. It can be a confusing, emotional roller coaster ride. Bon Secours Hospice helps by providing comfort to patients and their families, helping to control physical symptoms, and providing emotional and spiritual support.
What is hospice?
Hospice is a well-established model of care for patients at the end of life. It involves a team of professionals, including doctors, nurses, therapists, social workers, chaplains and volunteers, whose only goal is to ensure that each patient receives the individualized attention, respect, dignity and medical support they need.
When is hospice appropriate? And who can benefit most from this care?
Hospice is for end-of-life patients who wish to have as much control as possible over their care. It is most appropriate when a patient cannot be cured or opts to end aggressive and/or curative treatments. No formula exists for pursuing this option because each patient’s health and situation are unique. Patients often include – but are not limited to – those with end-stage diseases such as cancer, congestive heart failure, chronic obstructive pulmonary disease, kidney disease, advanced Alzheimer’s disease and other forms of dementia. Certainly, patients should consult their physicians who can make timely recommendations on hospice as a care option. Research shows the earlier a patient takes advantage of hospice, the more valuable it is for both the patient and their family. The Bon Secours Hospice staff can assist you in deciding whether or not hospice care is right for you.
Does a patient have to change doctors if they enter the Bon Secours Hospice program?
A patient’s regular physician is an important part of hospice care. If a patient enters hospice, their longtime physician can play an important role in advising and assisting other Bon Secours Hospice team members.
Where does hospice care occur?
Hospice care takes place in a variety of settings, including the patient’s home, hospitals, nursing, assisted living or nursing centers or freestanding hospice facilities, such as the Community Hospice House. Bon Secours Hospice provides service within a 60-mile radius of Richmond. When needed, short-term inpatient care also is available. This typically occurs when pain control or chronic-symptom management cannot be provided in other settings.
Does hospice do anything to hasten death?
Contrary to popular belief, hospice neither speeds nor slows dying. Rather, it supports patients in the final stage of life. Choosing hospice does not mean giving up hope. It’s about living life to the fullest – the fullest and most comfortable life the patient has in his or her remaining time. It’s not about adding time to their life, but rather about adding life to their time.
How does hospice manage pain?
Bon Secours Hospice’s nurses and doctors are up-to-date on the latest medications and devices for pain and symptom relief. Also, physical and occupational therapists may, when appropriate, assist some patients to become more mobile and self-sufficient. Other specialists conduct music therapy, art therapy, pet therapy, diet counseling and more for our hospice patients. Our approach to hospice care is grounded in the belief that emotional and spiritual pain are just as real and in need of attention as physical pain, so our program addresses these as well. Counselors, including chaplains and social workers, are available to assist family members and patients.
What is hospice’s success rate in battling pain?
The success rate is very high. Using a combination of medications, counseling and other therapies, most patients attain an acceptable level of comfort.
Will medications prevent the patient from being able to talk or know what’s happening?
There’s a delicate balance between managing the patient’s pain and maintaining his/her alertness. It is the goal of Bon Secours Hospice to help our patients be as comfortable and alert as they desire. By constantly consulting with the patient and their family, our hospice program has been very successful in reaching this goal.
If a hospice patient shows sign of recovery, can he/she return to regular medical treatment?
Yes. If a patient improves and the disease appears to be in remission, the patient can resume aggressive and/or curative treatment or return to his/her daily life. Typically, Medicare/Medicaid and most private insurers allow added coverage if a patient returns to hospice care at a later time.
Is hospice affiliated with any religious organization?
Hospice care is not an offshoot of any religion. While some religious groups have started hospices (sometimes in connection with their hospitals like Bon Secours), hospice programs serve a broad community and do not require patients to adhere to any particular set of beliefs.
Deciding to Enter Hospice Care
When should a decision about entering a hospice program be made? Who makes it?
It is appropriate to discuss all of a patient’s care options, including hospice, after a life-limiting diagnosis is made. The decision to enter hospice care is a deeply personal one and must – legally – be made by the patient him/herself. Bon Secours Hospice staff members are always available to discuss concerns or questions with patients, families and physicians.
Who should raise the question about possibly entering hospice – the doctor, the patient or the patient’s family?
The decision to enter hospice can be made by the patient alone or in conjunction with family. The first step is to consult the patient’s longtime physician. The second step is to rely on the knowledge, experience and expertise of the Bon Secours Hospice staff to assist you throughout the process.
Hospice Care at Home
What specific assistance does hospice provide home-based patients?
Bon Secours’s home hospice patients are visited several times a week by a team of nurses, social workers, certified nursing assistants, chaplains and/or volunteers who are also available 24/7 by phone. In addition, our team can help obtain medications, supplies, equipment, hospital services and additional helpers in the home, as appropriate.
Is there any special equipment or changes I have to make in my home before hospice care begins?
Bon Secours Hospice staff will assess your needs, recommend any necessary equipment, and help make arrangements to obtain it. Often the need for equipment is minimal at first and increases as symptoms progress. In general, Bon Secours Hospice will assist in any way possible to make home care as convenient, safe and comfortable as possible.
How many family members and/or friends are needed to care for a patient at home?
The number varies with each patient. Your Bon Secours Hospice team devises a care plan for the patient early in the process that addresses many topics, including the amount of care required for a given patient. In addition, hospice staff regularly visits patients to check on them and answer questions.
Must a friend or family member stay with the patient at all times?
Typically, patients do not require constant attention during the early weeks of hospice care. This may change over time. Because many patients fear dying alone, our team recommends someone stay continuously with a patient as he/she becomes weaker. Family and friends can assist with care. In addition, volunteers can run errands and be with the patient while regular caregivers take a break.
How difficult is caring for a hospice patient at home?
The process can be physically and emotionally draining. Your normal at-home routine is replaced with having to meet the needs of your loved one in a time of great fear and uncertainty. Nights especially can be long, isolating and unsettling. Our Bon Secours Hospice staff is available around the clock to consult with your family via phone and to make night visits when needed. Hospice care can also be provided in hospitals, assisted living or nursing centers and freestanding facilities, such as the new Community Hospice House in Richmond where around-the-clock care is provided.
Are respite services available?
Yes. Respite services give caregivers a much-needed break from attending to a patient at home. During these times, patients may spend their time in a hospital, assisted living or nursing center, or the Community Hospice House. Bon Secours Hospice also offers continuous care during a crisis when there is a desire to keep the patient at home.
Paying for Hospice Care
Is hospice covered by insurance?
Hospice coverage is provided by Medicare nationwide, by Medicaid in 47 states, and by most private health insurance policies, depending on a patient being able to satisfy certain criteria. To be eligible for hospice coverage under Medicare or Medicaid, a patient must have a medically confirmed “terminal illness,” which is defined as having a life expectancy of six months or less if the illness runs its normal course. You also must choose to receive hospice/palliative care services rather than active treatment for the illness.
The Medicare/Medicaid Hospice Benefit usually pays for many services, including medical supplies, equipment and prescriptions that are directly related to the hospice diagnosis, as well as respite care and other services. The Bon Secours Hospice team staff will assist you throughout this process.
If a patient has no insurance coverage, can hospice care still be provided?
Yes. No one is ever turned away from Bon Secours Hospice because of his or her inability to pay. However, the hospice staff will check to see if the patient is eligible for any coverage of which they may be unaware. If a patient has no coverage and meets certain regulatory criteria, care will be provided and paid for through charitable donations from the community.
Who pays for medications, supplies and medical equipment?
A patient’s Hospice Medicare/Medicaid Benefit or private insurance usually pays for medications, supplies and medical equipment tied to hospice-related diagnoses.
If the patient is eligible for Medicare, will there be any additional expenses?
Medicare usually covers all services and supplies related to the diagnosis of the hospice patient. In some cases, the patient may be required to pay a 5% or $5 copayment on medication and a 5% copayment for respite care. You should discuss these fees with your employer or health care provider when choosing a hospice program.
Who pays when a hospice patient requires hospitalization?
The hospice Medicare/Medicaid Benefit covers a hospital or hospice facility stay for symptom management related to a hospice illness. The patient’s physician and the Bon Secours Hospice team make the admission decision. At Bon Secours, admission must be authorized first by calling 804-627-5360 or toll free at 866-664-6344. Our staff will assist you throughout the process.
What if a patient’s physician doesn’t know about hospice?
Most doctors are at least aware of hospice care. If your physician would like more information, have them contact Bon Secours Hospice, the American Academy of Hospice and Palliative Medicine, medical societies, state hospice organizations, local hospices or the National Hospice and Palliative Care Organization Helpline at 800-658-8898. In addition, you can learn more from the American Cancer Society, the American Association of Retired Persons and the Social Security Administration.
Hospice Admissions Process
How does the hospice admission process work?
The process begins with a discussion between patients, families and doctors, which can be facilitated by the Bon Secours Hospice staff. The formal admission process starts with the hospice staff contacting a patient’s physician to ensure that the doctor agrees that hospice care is appropriate. Once approved, the patient signs consent and insurance forms that are similar to forms required to enter a hospital and state that the patient understands that care is palliative rather than curative. (Palliative means relieving pain and controlling symptoms rather than curative treatments.) This form also outlines the services provided. Medicare patients also sign a form that explains how choosing Medicare hospice benefits for a life-limiting illness affects other Medicare coverage.
Does Bon Secours Hospice assist families after a patient dies?
Yes. Hospice provides bereavement support for family and friends for a year after a loved one’s death. Please click here for more detailed information.
Supporting Hospice Care
How do people donate to support hospice?
Donations to support the Bon Secours Hospice program are welcomed and appreciated at any time. Please send checks to:
Bon Secours Richmond Health Care Foundation
7229 Forest Avenue
Richmond, VA 23226
Or you may donate online at www.bsvaf.org/supporthospice.
What are some good online resources about hospice and related issues?
Some of the best include:
- National Hospice and Palliative Care Organization
- Virginia Association for Hospices and Palliative Care
- Caring Connections
- Advanced Directives
- Hospice Patients Alliance